Please fill in the below Due Diligence Questionnaire prior to engaging in any relation with our company. We reserve the right to select our clients after the analysis of the information received through this Due Diligence Questionnaire. Form Type * Company Person Name of registering person * E-mail address of registering person * Company name, name or designation: * Legal form: * Registration number (if available) Address of the registered seat or head-office: * Names of the members of the representatives body or legal representatives: * If a member of the representative body or a legal representative is a legal person, please provide its company name, name or designation, registration number (if available) and address of the registered seat or head-office: Please confirm whether, with respect to this engagement, the company you represent is acting for [its/his/her] own account or on behalf of a beneficial owner (the latter term includes trust arrangements, foundations and acting on the instruction of another). Please check one of the following and provide the required information: * You confirm that the company you represent is acting for its own account with respect to this engagement. The company you represent acts on behalf of a beneficial owner. You provide the following information as to the beneficial owner. Name of the beneficial owner: * Please check one of the following three alternatives and provide the required information: * The company you represent is listed on a stock exchange (Note: inclusion is over-the –counter trading or similar markets is not sufficient). The company you represent is a direct or indirect wholly owned subsidiary of a company listed on a stock exchange (Note: inclusion is over-the –counter trading or similar markets is not sufficient). Neither the company you represent nor its parent company are listed on a stock exchange. Accordingly, you provide the following information: Stock exchange: * Name of parent company and stock exchange: * You confirm that no individual has direct or indirect control over more than 25% of the capital or the voting rights of the company you represent; or You will enclose in the upload area below an organizational chart showing individual holdings in the company you represent exceeding 25% of the capital or the voting rights. (Note: in case of multi-layer corporate structure, the organizational chart must permit the identification of all individuals directly or indirectly controlling 25% or more of the shares in the company, whether through a majority of voting rights or under a contractual agreement). The names and addresses of these individuals must be included. Organizational chart * Upload Files must be less than 8 MB.Allowed file types: pdf. Please send us an extract from the commercial register, registry of mutual associations or comparable official register relating to the company you represent. * Upload Files must be less than 8 MB.Allowed file types: pdf. Full name as per identity document * Identity document (.PDF file) * Upload Files must be less than 8 MB.Allowed file types: pdf. Social Security / Personal Identification number * Registered home address, city, province, postcode, country * Contact telephone number(s) * E-mail address * Date of birth * MonthJanFebMarAprMayJunJulAugSepOctNovDec Month Day12345678910111213141516171819202122232425262728293031 Day Year Nationality and place of birth * Other citizenship(s) Country of residence Occupation Nature of business intended for proposal, geographies involved and expected type of counter-parties (as applicable) Are you politically involved? * Yes No Do you have politically involved relatives? If yes, please specify * Do you have any business relation to any company(ies) owned by a politically involved person? If yes, please specify * By submiting this form, you agree to our terms and conditions: Read our terms and conditions By submiting this form, you agree to our terms and conditions: Read our terms and conditions CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image. Submit